peripheral stem cell transplantation in treating patients with hematologic cancer

Conditions: Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes

Summary: rationale: peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy or radiation therapy used to kill tumor cells. purpose: phase ii trial to study the effectiveness of peripheral stem cell transplantation from related donors to prevent graft-versus-host disease in treating patients with hematologic cancer.

objectives: i. evaluate the use of donor peripheral blood stem cells without graft-versus-host disease prophylaxis to maximize the probability of graft-versus-tumor effect in patients with hematologic malignancies refractory to standard chemotherapy and unlikely to be cured with high dose chemotherapy and radiotherapy. outline: prior to peripheral blood stem cell transplant, patients undergo preparative cytoreduction. patients receive total body irradiation (tbi) beginning on day -5. radiotherapy is administered in 9 doses over 3 days (3 doses per day for 3 days). male patients with acute lymphocytic leukemia receive an additional dose of radiation to the testicles. patients who are ineligible for tbi due to prior radiotherapy receive 2 doses of melphalan iv on day -3. all patients receive cyclophosphamide iv over 1 hour on days -2 and -1. anti-thymocyte globulin is also administered iv over 6 hours on days -2 and -1. approximately 24-36 hours after the last dose of cyclophosphamide, peripheral blood stem cells obtained from the hla matched related donor are infused into the patient. patients do not receive graft-versus-host disease prophylaxis after transplant; however, all other forms of supportive care are provided. patients are followed for 1 year. projected accrual: a maximum of 42 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: patients with hla identical family donors and any one of the following conditions documented by marrow aspiration and biopsy: -acute leukemia refractory to induction treatment or after 1 or more relapses -acute myeloid leukemia with t(9;22), -5/5q-, -7/7q-, and 11q23 involvement in first remission (not m4 or m5) -acute lymphocytic leukemia with t(9;22) or t(4;11) in first remission -myelodysplastic syndrome with greater than 5% bone marrow blasts -chronic myeloid leukemia in accelerated phase or nonlymphoid blast crisis -myeloma, chronic lymphocytic leukemia, non-hodgkin's lymphoma, or hodgkin's disease refractory to 2 lines of standard treatment or progression on standard treatment no evidence of active extramedullary disease patient characteristics: age: any age performance status: karnofsky 70-100% life expectancy: greater than 8 weeks hematopoietic: not specified hepatic: bilirubin less than 2.0 mg/dl sgot no greater than 4 times upper limit of normal and not increasing for 2-4 weeks prior to transplant renal: creatinine less than 2 times normal and not increasing for 2-4 weeks prior to transplant or creatinine clearance greater than 60 ml/min cardiovascular: lvef greater than 50% by muga pulmonary: dlco greater than 50% other: not hiv positive not pregnant or nursing fertile patients must use effective contraceptive prior concurrent therapy: see disease characteristics

Keywords: recurrent childhood acute lymphoblastic leukemia recurrent adult hodgkin lymphoma refractory multiple myeloma waldenstrom macroglobulinemia stage i multiple myeloma stage ii multiple myeloma stage iii multiple myeloma recurrent childhood lymphoblastic lymphoma recurrent childhood acute myeloid leukemia recurrent adult acute myeloid leukemia recurrent adult acute lymphoblastic leukemia relapsing chronic myelogenous leukemia refractory chronic lymphocytic leukemia accelerated phase chronic myelogenous leukemia blastic phase chronic myelogenous leukemia adult acute myeloid leukemia in remission adult acute lymphoblastic leukemia in remission childhood acute myeloid leukemia in remission childhood acute lymphoblastic leukemia in remission adult acute erythroid leukemia (m6) adult acute myeloblastic leukemia without maturation (m1) adult acute myeloblastic leukemia with maturation (m2) adult acute promyelocytic leukemia (m3) adult acute eosinophilic leukemia adult acute basophilic leukemia adult acute megakaryoblastic leukemia (m7) childhood acute myeloblastic leukemia without maturation (m1) childhood acute myeloblastic leukemia with maturation (m2) childhood acute promyelocytic leukemia (m3) childhood acute erythroleukemia (m6) childhood acute eosinophilic leukemia childhood acute basophilic leukemia childhood acute megakaryocytic leukemia (m7) recurrent/refractory childhood hodgkin lymphoma recurrent grade 1 follicular lymphoma recurrent grade 2 follicular lymphoma recurrent grade 3 follicular lymphoma recurrent adult diffuse small cleaved cell lymphoma recurrent adult diffuse mixed cell lymphoma recurrent adult diffuse large cell lymphoma recurrent adult immunoblastic large cell lymphoma recurrent adult lymphoblastic lymphoma recurrent adult burkitt lymphoma previously treated myelodysplastic syndromes adult acute minimally differentiated myeloid leukemia (m0) childhood acute minimally differentiated myeloid leukemia (m0) recurrent childhood small noncleaved cell lymphoma recurrent childhood large cell lymphoma recurrent mantle cell lymphoma recurrent marginal zone lymphoma recurrent small lymphocytic lymphoma extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue nodal marginal zone b-cell lymphoma splenic marginal zone lymphoma childhood myelodysplastic syndromes